You've heard how effective EMDR is for trauma, right?
Almost sounds like magic.
And yet maybe you've also heard from some people who felt that EMDR made their situation
worse, particularly if they had complex PTSD.
Now, how horrible would it be to go for therapy for trauma and have it make things worse?
By the end of this video, you will know whether you or a loved one has complex PTSD, whether
EMDR can help and what you can do about it.
Now, if you're new to my channel, my name is Barbara Heffernan.
I'm a psychotherapist who specializes in anxiety and trauma.
I started this channel to bring more people information on how they can recover from anxiety
and trauma.
And if you support the work that I'm doing, please subscribe to my channel.
Give me a like on this video and comment below after you watched it.
So, can EMDR help complex PTSD?
Does it make things worse?
Does it make things better?
Have you heard things about EMDR that feel scary and a little overwhelming?
Well, stay tuned.
So first I will briefly review what PTSD is and what makes it complex.
Second, I have a few tough questions for you - some self-assessment that is necessary prior
to moving forward with this process.
And third I'll explain the best practices for an EMDR therapist to use with somebody
who has complex PTSD.
And lastly, I'll mention a few things that you can do now to help.
So, what is post-traumatic stress disorder, PTSD, and what makes it complex?
Well, PTSD is a cluster of symptoms that can occur after a trauma and what a trauma is
something am I going to come back to a little bit later in the video because it's very important
to talk about the definition of trauma when you're thinking about complex PTSD and whether
you might have it and the cluster of symptoms that give somebody that diagnosis.
I'm going to show you a slide - here are intrusion symptoms, avoidance symptoms, negative changes
in cognition, which are thoughts and negative changes in mood and hyperarousal.
And generally, when people talk about complex PTSD, they are also bringing in dissociative
symptoms.
So posttraumatic stress disorder can be diagnosed with or without dissociation.
And then there also are other diagnoses of dissociative disorders.
So generally dissociation is a key piece of complex posttraumatic stress disorder.
So, dissociation can be depersonalization, which is feeling detached from one's body
or one's thoughts, feeling as if we're in a dream, feeling a sense of unreality of self
or feeling a sense of time moving very slowly.
And then there is also the category of derealization - feeling as if the world around you is not
real, the world around you is a dream is very distant or is distorted.
So those are dissociative symptoms that can go with a diagnosis of PTSD that generally
will be considered complex PTSD.
And then there are also dissociative experiences that have their own diagnoses, so to speak.
For example, dissociative identity disorder is what in layman's terms would be called
multiple personality disorder where somebody is so dissociative that they have multiple
parts.
And I also want to say about dissociation is that dissociation exists on a spectrum.
So, there are some dissociative experiences that are very, very, very common - like most
people have the once in a while, for example, listening to somebody talk and you just space
out, you're not paying attention.
That's a little bit dissociative, but generally, that's viewed more as a disruption in attention
rather than a disorder.
And then dissociative symptoms go all the way along a spectrum - all the way to a full
multiple personality disorder, which would be dissociative identity disorder.
And I also just want to throw in here that if you are having any of these symptoms, these
are treatable conditions.
These are not your fault and these are not because there's something wrong with you,
it's because something wrong happened to you.
And that's very important to understand what was wrong is what happened to you, not your
response to it.
Factors that contribute to complex PTSD include repeated childhood abuse, both emotional abuse,
and physical abuse, sexual abuse as a child and ongoing childhood neglect.
And then the warning signs in terms of the symptoms you might be having are the dissociative
symptoms - extreme swings in mood, extreme self-destructive behaviors, and also feeling
numb.
Almost the opposite of the extreme swings and mood could be a fairly pervasive feeling
of being numb.
And here is where I'd like to come back to the definition of trauma, according to the
DSM five.
The DSM five is the guideline of how people in my position diagnose people.
It's published by the American psychiatric association and it's how therapists, psychiatrists,
psychologists come up with their diagnoses.
And in the DSM five the definition of trauma, I'm going to show it to you here, is exposure
to actual or threatened death, serious injury or sexual violence by directly experiencing
the traumatic event or witnessing in person the event happening to others, or learning
that the event occurred to a close family member or friend or experiencing repeated
or extreme exposure to aversive details of the event.
So, for example, if you are a psychotherapist or you are a first responder, a fireman, a
policeman, you might get what we call vicarious traumatization.
However, missing from this definition is one of the things that I see causing complex post-traumatic
stress disorder almost more than anything else.
And that is childhood neglect.
So, I will have clients who have complex post-traumatic stress disorder and they'll tell me, but nobody
hit me when I was a kid.
I was never sexually abused.
Because neglect is actually almost like an invisible abuse.
Ongoing situations of neglect as a child really, really, really impact our sense of self, our
relationship to the world.
Children need the love and caring attention of a parent.
So, with pure neglect, you may not be given a diagnosis of post-traumatic stress disorder,
but in my experience, it would apply.
So the second thing I said I would talk about today is the self-assessment that I feel is
really necessary if you are considering moving forward with EMDR and this is where it's super
important to be really honest with yourself and if you're seeing a therapist to be really
honest with the therapist and the things to consider are one, are you engaging in significant
self-harming behaviors?
Two, are you drinking too much, taking opiates, taking benzodiazepines or abusing drugs?
And benzodiazepines are very commonly prescribed Xanax, Valium, those are benzodiazepines and
they can be very addictive.
Are you suffering from bulimia or Anorexia and are you living in a safe environment?
Trauma treatment will be very complicated if the environment you're living in is not
safe and that's any trauma treatment, whether it's EMDR or any other method of trauma treatment
because it's very important to be able to begin to access feelings of physiological
safety.
And if you're not living in an emotionally or physically safe environment, that can be
very difficult to do.
So, if you have answered yes to any of those questions, work on those things first.
You and your therapist can focus on changing those items with the help of 12 step recovery
programs can be very, very helpful.
Eating disorder programs, domestic violence programs and there are some EMDR protocols
that can help all of these things, but they are not the active trauma processing portion
of EMDR.
As I mentioned in my video.
How does EMDR work?
EMDR is a comprehensive technique.
It is not just the bilateral stimulation, the eye movement piece, which gets so much
attention.
So there really are many other elements of EMDR therapy that can help in these situations
and with complex post-traumatic stress disorder.
So in addition to talking about those tough questions that I just listed, the EMDR therapist
should do two things with you prior to beginning any kind of active processing.
And one of those is to make sure that you can access a safe place.
This is a visualization exercise which EMDR therapists do with their clients to make sure
the client can visualize being somewhere safe and then also feel physiologically those feelings
that go with it.
And I actually have a small mini-course that walks you through the safe place exercise.
If you're interested, you can access that for free with the link below.
The other thing that EMDR protocol says to do prior to beginning any kind of active processing
is a dissociative evaluation is really to speak with the client.
So your therapist should be speaking with you about how many dissociative symptoms you
have and how severe they are and how you guys can manage them.
So, some of the best EMDR protocols for someone who has complex post-traumatic stress disorder
include the following positive reinforcement using dual stimulation.
Your therapists can work with you on positive cognitions about the self and positive experiences
you've had in your life and really reinforce those using the bilateral stimulation.
So that's a very important stabilization phase prior to beginning active processing.
Working with relaxation techniques, again to access that feeling of physiological safety.
Those are things you can do with your therapist.
And there are also things you can do on your own.
Emotional regulation techniques, learning how to modulate your moods, learning how to,
we call it up-regulate when you need to sort of increase your energy and down-regulate
when you need to calm down.
Because we learn best when we are within an optimal zone of tolerance.
So if our normal mood is like this, that's where we learn best.
When we get too anxious, excited, hyper, we're not learning well.
And when we get too depressed, when we are too low, we don't process well.
So our brains are not going to be able to fully process and integrate and move the traumatic
memories into a more adaptive memory mode with too much mood regulation.
So working on techniques to be able to regulate your own mood, very important.
And establishing a safe and secure relationship with your therapist prior to active processing
is very important.
Other protocols that an EMDR therapist can use can be to increase your awareness of the
degree of dissociation.
And this is something that would be great if you can begin to talk to your therapist
about it.
So some therapists will use a technique where they'll say like, how much in the room are
you now?
Like this would be like, I'm here, I'm 100% right here right now.
And here.
Like, no, I'm disappearing.
And sometimes I can tell when a client is moving between these states and sometimes
I really can't tell so on these or pause to ask them or when they can learn that like,
whoa, they're beginning to sort of disappear from the moment they can tell me that.
And then we can use some grounding techniques.
Grounding techniques are really important and those are about staying present and in
the moment.
So there are other EMDR protocols that often are used for complex PTSD including something
called the conference room parts work moving technique.
I could go on and on about this stuff, but there are techniques that can be used to help
with complex post-traumatic stress disorder before you jump into active process.
If a therapist and a client moved too quickly into active processing for somebody who has
dissociative symptoms and complex post-traumatic stress disorder, it can be very, very disregulating
and incredibly difficult for the client.
In which case often the client will drop out or they might go into a depression or they
might really sort of decline in terms of their functioning.
So with dissociative symptoms, you want to take this process slowly.
So what steps can you take?
One is to find an EMDR therapist with experience with complex post-traumatic stress disorder
and association.
Next is to be willing to stay the path, be committed to an extended period of treatment.
This will not be a super-fast course of treatment.
Know that in between sessions you may feel worse and that would be something to discuss
with your therapist and come up with tools and techniques of what you can do in between
sessions.
When you're in the middle of processing something, when you actually do begin the processing
and having trust in your therapist is key.
If you don't trust your therapist, it probably will not work with that person.
Now again, people with complex posttraumatic stress disorder, sometimes they don't feel
like they can trust anyone.
So there is really a discretion that you'll need to use in terms of figuring out is this
therapist trustworthy?
Are my feelings of not trusting this therapist part of my trauma or are they, because I really
just don't feel comfortable with this therapist in particular.
So that's an important piece for you to figure out and then be open with your therapist.
Therapists can't help you if you hide information and it's unbelievable how often clients will
not tell me something for long, long periods of time, which I totally understand.
It's part of that building trust, but that also really does slow down therapy.
And when that happens, I don't fully have the information I need to help make the decisions
about which directions we take or what advice I give the client or how I help guide them
to heal and to feel better.
So I truly hope that this video has helped clear up some of the confusion around whether
EMDR can work for complex post-traumatic stress disorder.
And if you have any questions about this at all, please leave them in the comments below.
Or you can go to my website and then email me.
Please share this video with a friend if you found it helpful and you think it might be
helpful for them.
And please give me a like and comment below.
And I look forward to seeing you the next time.